全身麻醉和硬膜外麻醉用于老年骨科患者的比较

发布时间：2019-04-16 15:42

【摘要】：目的 :探讨全身麻醉和硬膜外麻醉对老年骨科患者凝血功能及术后认知功能的影响。方法 :选取2015年2月至2016年2月拟在我院进行全膝关节置换术的98例患者,按照麻醉方式的不同分为两组:A组(硬膜外麻醉组,50例),B组(全身麻醉组,48例)。分别于麻醉前(T1)、麻醉后6h(T2)、术后24h(T3)抽取两组患者的静脉血5m L,检测患者血清中血小板含量、纤维蛋白原浓度(FIB)、凝血原酶时间(PT)、部分激活凝血活酶时间(APTT)、D-二聚体水平,并分别于麻醉前(T1)、麻醉后6h(T2)、术后24h(T3)、麻醉后3d(T4)、麻醉后5d(T5)时间点采用简易精神状态评分量表(MMSE)评估患者的认知功能。结果 :两组患者一般情况比较差异无统计学意义,具有可比性;两组患者T1时点PT、APTT、FIB、D-二聚体、血小板含量相比差异无统计学意义,T2~T3时点,两组患者PT均高于术前水平但组间相比无统计学意义,A组患者APTT明显高于B组而FIB、D-二聚体、血小板含量明显低于B组,差异有统计学意义;两组患者T1、T5时间点MMSE评分相比差异无统计学意义,T2~T4时间点A组MMSE评分显著高于B组,差异有统计学意义。结论:与全麻相比,对老年骨科患者实施硬膜外麻醉不仅能够显著改善凝血功能而且对患者术后认知功能的影响更小,更有助于患者术后的恢复。
[Abstract]:Objective: to investigate the effects of general anesthesia and epidural anesthesia on coagulation function and postoperative cognitive function in elderly orthopedic patients. Methods: from February 2015 to February 2016, 98 patients with total knee arthroplasty were divided into two groups: group A (epidural anesthesia group, n = 50) and group), B (general anesthesia group, n = 48). Before anesthesia (T1), 6 hours after anesthesia (T2) and 24 hours after anesthesia (T3), the venous blood samples of the two groups were taken to detect platelet content, fibrinogen concentration, (FIB), thromboplastin time (PT),. The time of partial activation of thromboplastin (APTT), D-dimer) was measured before anesthesia (T1), at 6h (T2) after anesthesia, at 24h (T3) after anesthesia, and at 3D (T4) after anesthesia. The cognitive function of the patients was assessed by mini mental state scale (MMSE) at 5 days after anesthesia (T 5). Results: there was no significant difference in the general situation between the two groups, and there was comparability between the two groups. There was no significant difference in PT,APTT,FIB,D- dimer and platelet content between the two groups at T1 point. At T2~T3 time point, PT in both groups was higher than that before operation, but there was no significant difference between the two groups. APTT in group A was significantly higher than that in group B while FIB, was significantly higher in group A than in group B. The levels of D-dimer and platelet in group B were significantly lower than those in group B (P < 0.05). There was no significant difference in MMSE scores between the two groups at time point T 1 and T 5, but MMSE score in group A was significantly higher than that in group B at the time point of T2~T4 (P < 0.05). Conclusion: compared with general anesthesia, epidural anesthesia in elderly orthopedic patients can not only significantly improve coagulation function, but also has less effect on postoperative cognitive function, and is more helpful to postoperative recovery.
【作者单位】：北京市海淀医院麻醉科;
【分类号】：R614

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